GPSIs 'are dearer than outpatient services'
By Joanna Clarke-Jones
Clinics run by GPs with a special interest cost almost twice as much as equivalent hospital outpatient services and may not be cost-effective, Government-commissioned research has concluded.
The study by the University of Bristol found the cost of
attending a GPSI dermatology service was £208, compared with £118 for outpatient care.
Researchers said the extra cost had to be weighed against improved access provided by the GPSI services and marginally higher patient satisfaction and clinical outcomes.
But they added that the introduction of the Payment by Results tariff system would force PCTs, or practice-based commissioners, to question whether this was enough to compensate for the significant extra expense.
Author Professor Chris Salisbury, professor of general practice at the University of Bristol and a GP in the city, said there was a 'danger GPs with a special interest will price themselves out of the market'.
He said: 'The GPSI service we looked at is more expensive than the tariff for Payment by Results. If that is true, then it would not be economic.
'Commissioners would not be able to provide services for the tariff price. Payment by Results will concentrate the mind on whether the service is cost-effective.'
Those buying services would have to place a high value on access to justify using GPSIs, Professor Salisbury added.
The research, which involved 554 patients across 29 practices in Bristol, found one reason
GPSI services were more expensive was because patients always saw a GP. In hospitals patients often saw a registrar or clinical assistant.
Dr Michael Lacey, a GP in Chichester, West Sussex, who also works as a hospital practitioner in dermatology, said
GPSIs should work alongside dermatology teams in hospitals.
'I don't think GPSIs are cost-effective,' he added.
He also questioned whether many GPSIs were working within appropriate clinical guidelines.
But Dr John Adams, a GPSI in dermatology in Stockport, said the improvements in access should not be underestimated when judging the success of the service. He said: 'Car parking and accessibility is very important to patients who use our services and they are very satisfied with them.'